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Pediatric Surgeon Criticizes Mayo Clinic Circumcision Rates Article

We interviewed Professor Kevin Pringle of Wellington, New Zealand for his professional opinion on the latest pro-circumcision article from the Mayo Clinic Proceedings Journal.
Professor Kevin Pringle
Professor Kevin Pringle

We recently interviewed Professor Kevin Pringle, one of the first medical professionals to criticize the Mayo Clinic's "Circumcision Rates" article. Here is the transcript from the interview.

On April 4, the Mayo Clinic Proceedings Journal published an online article entitled, “Circumcision rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have?” The authors of this article claim that circumcision does not decrease sexual function, has significant health benefits, and should be treated like childhood vaccinations. How did you hear about the “Circumcision Rates” article and what was your initial reaction to it?

Prof. Pringle:
I'm a member of the faculty of the university of Otago and had my name on a database of potential experts that might be contacted and so I was contacted by the Science Media Center, which is an independent organization, and sent an embargoed copy of the paper and asked to comment on it. It resulted in a very intense flurry of activity. But that's how I heard about it.

My big concern initially was that the fact that in my view the authors have absolutely minimized the risks of circumcision and to say that circumcision should be packed up there alongside vaccination is just, sorry, that's crazy. The risks one takes for a vaccination, by the time you've driven your child to the doctors, you've taken more risk than you've taken to get the actual vaccination.

Vaccinations protect against serious lethal diseases. If you really want a sedentary example of that, go and find yourself an old cemetery and have a look at the number of headstones a hundred years ago that relate to children in the first few months of life. And then go to a modern cemetery and see how few there are. The difference is vaccination. There's no way that that equates to the benefits that you get from circumcision.

What experience do you have with circumcision? Is it something that you've been trained to do? Is it something that you see in your clinical experience?

Prof. Pringle:
I wasn't really trained to do this in medical school, that sort of training is a post-graduate thing, but I was certainly trained as a part of my pediatric surgical training to do circumcisions.

In New Zealand, circumcision is the exception rather than the norm. In fact, the government does not fund cultural religious circumcisions. So if you do you want it done to your child then you would have to pay for it in kind.

We do do circumcisions for children that have phimosis that does not respond to steroids. But in fact something like 80% of the phimosis I see respond to a course of steroids if the steroids are applied properly. So that's not a major issue.

The experience that I've had, I certainly end up on the receiving end of the bad complications. Over the last three to four years, we've had four or five children, they were neonatal circumcisions, one of whom very nearly died of sepsis, and the rest of them had significant damage to the tip of the penis. At least one of those has had a secondary meatotomy because the opening of the penis was very significantly narrowed.

So, again, I try to make the point that this is not the benign procedure that it's posted as.

Let's go back to the latest American Academy of Pediatrics' circumcision policy statement.. In 2012, the American Academy of Pediatrics, the AAP, changed its circumcision policy statement to say that the benefits of circumcision outweigh the risks enough for it to be offered as a choice to parents, and for third-parties to offer insurance coverage, but not enough to recommend routine infant circumcision. This policy statement was widely criticized by the AAP's European counterparts for cultural bias, and there was even an article in the AAP's own journal to this effect.

What are your thoughts on the 2012 AAP circumcision policy statement?

Prof. Pringle:
When you read the statement the group did their level best to be very selective as to the quality of the articles that they then chose to use their evidence base. I guess my concern is that a lot of the articles that they chose to support the benefits come from places like Africa and I don't think that that's the same as if the same sort of articles that were sourced were coming from Scandanavia.

There is actually quite one paper that supports the fact that the incidence of penile cancer is extremely low in Scandanavia and I go back to the point that I made in my original comment on the article that it's cleanliness not godliness that makes that difference.

Prof. Pringle is a Professor of Paediatric Surgery and Head of the Department of Obstetrics & Gynaecology at the University of Otago, Wellington. He is also the Clinical Leader for Paediatric Surgery at Capital & Coast District Health Board, based at Wellington Regional Hospital.

Disclaimer: The views present in this interview do not necessarily represent the views of IntactNews.


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